Paramedics face same patients again and again

Caring for repeat callers pulls crews from other emergencies, night after exhausting night

San Diego Rural/Metro EMT Ray Madrid recognizes a man who was found intoxicated and unconscious on a city sidewalk as a "frequent flier', a term emergency service workers use for patients who use the emergency system more than six times a year, often at a high taxpayer cost. By law, the 911 system and emergency departments must treat all patients, regardless of insurance status.
— James Gregg

San Diego Rural/Metro EMT Ray Madrid recognizes a man who was found intoxicated and unconscious on a city sidewalk as a "frequent flier', a term emergency service workers use for patients who use the emergency system more than six times a year, often at a high taxpayer cost. By law, the 911 system and emergency departments must treat all patients, regardless of insurance status.
— James Gregg

The engine of Fire-Rescue Co. 7 heaved out of the station on a recent night — wailing past couples bound for the Gaslamp Quarter straight to a man who was sprawled, legs akimbo, on a dirty third-floor walkway.

The address was familiar: a Father Joe’s Villages housing complex. The victim was recognizable: an epileptic man with a history of substance abuse whom firefighter/paramedic Dave Stepp treated blocks away just days before.

“Relax. Sit back. Relax. You’ve had a seizure,” firefighter Tim Hill reassured the patient, as Stepp opened a toolbox of medications. Hill placed his thick boots on each side of the man’s body and stood over him at 200 pounds. He knew firsthand that seizure victims can recover violently, and did not want to see the needle about to be injected by Stepp reversed in a struggle.

“Was he full-on convulsing?’’ Stepp asked a gallery of onlookers who leaned on the walkway rail.

“He was flopping. It looked like his head and shoulders and stuff,” answered a voice from the crowd, as another crew member cradled the victim’s head through rubber gloves.

The 47-year-old man, later identified as Douglas Rickey, is one of the city’s estimated 1,136 frequent emergency services users, or “frequent fliers,” as first responders cynically dub the mostly homeless patients. And this — a routine call for the four-man crew — is the merry-go-round of medical care provided to the needy population night after exhausting night.

“Frequent fliers and their caregivers are stuck in a revolving door of transports, expensive tests and discharge instructions that the patients either refuse to follow, or are unable to follow,” said Dr. James Dunford, medical director for the city of San Diego.

Dunford, in charge of a $211 million budget that funds 1,182 personnel on the front lines, added: “Millions of taxpayer dollars are being squandered on people who repeatedly use 911.”

His office defines a frequent user as someone who is on course to turn to the 911 system at least six times a year. An evaluation of 911 responses conducted by his staff found that they will ring up more than $20 million in fire and ambulance bills this year alone.

So in an era of dwindling budgets and burgeoning need, Dunford is working with United Way of San Diego “Home Again” Commissioner Brian Maienschein to coax the most chronic frequent users from the streets by providing a coordinated system of medical care, complete with housing and supportive services.

The reason: It is much cheaper to provide frequent users the broad array of assistance than leave them on the street in constant need of ambulances and emergency rooms.

“This has become a vanguard to the approach from a national level,” said Don Lundy, president-elect of the Mississippi-based National Association of Emergency Medical Technicians, which represents 32,000 EMS workers nationwide.

But Lundy, who discourages crews from using the “frequent flier” label because he finds it disrespectful to people in need, cautioned that in an age where both private and public medical insurance coverage is marked by long waits for a doctor’s appointment — if you have coverage at all — 911 will increasingly become the only reliable option.